An Introduction to Health Psychology

CHAPTER 1
UB/SIM Program
PSY 325
Instructor: Dr. Jean DiPirro

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 Chapter Outline
• I. What is health?
• II. Changing field of health
• III. Psychology’s role in health
• IV. Emergence of health psychology
• V. Biopsychosocial model
• VI. Related fields
•VII. Research methods

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I. What is health?

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 Definition of Health

• Common definitions focus on LACK of ILLNESS

 lack of objective signs (e.g., high blood pressure)
 lack of subjective symptoms (e.g., pain, nausea)
• Alternative: Illness/Wellness Continuum (IWC)
 concepts of health & sickness overlap
 Antonovsky proposed an IWC with 2 polar ends:
death/illness/disability and optimal wellness (see
page #3 of textbook)
 need to change focus from what makes people sick to
what keeps people well

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 Definition of Health

• Definition we will use in this class

 Health = positive state of physical, mental and
social well-being that varies over time along a
continuum

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 II. Changing Field of Health

20th century & present

• changing patterns of disease & death
• rising cost of medical care
• changing model of health
Changing Patterns of Disease & Death

 TODAY (in industrialized nations)

• Greater longevity
• Different patterns of illness

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Changing Patterns of Disease & Death

Disease before 1900

• pneumonia
• infectious
• tuberculosis
• short lasting
• diarrhea & enteritis
• heart disease
• liver disease
• injuries
• cancer
• senility
• diphtheria
Changing Patterns of Disease & Death
• heart disease
Disease after 1900 • cancer
• chronic in nature • stroke
• behavior & lifestyle • chronic lower
respiratory disease
• unintentional injuries
• pneumonia/influenza
• diabetes
• kidney disease
• suicide
• chronic liver disease
Changing Patterns of Disease & Death

• Important factors in health & life expectancy

 ethnic background
 income level
 sex
 age
 education level
 availability/access to medical care &
treatment
 Rising Cost of Health Care
• 1975 – 1998
 >600% increase annual cost per person (U.S.)
• Causes
 increased longevity
 expensive medical procedures (used on relatively
few people)
• Solutions
 early detection of problem
 greater emphasis on health-promoting behavior
 Changing Models of Health
• Biomedical model
 disease is produced by pathogen exposure
 health = absence of disease
 focus is on disease, not health
 the “person” is left out of the equation

• Biopsychsocial model
 health is multidimensional
 health is due to biological, psychological, & social
factors  the “person” is important
 health = positive state
III. Psychology’s role in health

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 “The Person” in Health & Illness

• Individual differences in tendency toward illness are

due to
 biomedical sources such as physiological
processes or exposure to microorganisms
 psychological and social factors

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 “The Person” in Health & Illness

• Relationship between lifestyle & illness

 Lifestyle modifications (changes in everyday patterns
of behavior) may affect characteristics associated with
health problems
 Risk factors = biological or behavioral
characteristics/conditions associated with
development of a disease or injury
• e.g., genes, smoking, eating a diet high in
saturated fat
• having more risk factors is associated with (but
doesn’t necessarily cause) higher likelihood of
developing the disease
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 “The Person” in Health & Illness
• Behavioral risk factors associated with 5 leading
causes of death
 heart disease = smoking, high dietary cholesterol,
obesity, lack of exercise
 cancer = smoking, high alcohol use, diet
 stroke = smoking, high dietary cholesterol, lack of
exercise
 COPD (chronic obstructive pulmonary disease) =
smoking
 accidents = alcohol/drug use, not using seat belts
• Lifestyle  health problems & high medical costs
 society bears burden of medical costs through public &
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private insurance programs
 “The Person” in Health & Illness
• Influence of lifestyle factors on health
 7 lifestyle practices linked to current & future health
(Belloc & Breslow, 1972): See self-assessment survey on page #8
of the textbook, but note year of study. (Other factors, not listed,
may also be important.)
• Sleeping 7-8 hours per day
• Eating breakfast almost every day
• Rarely eating between meals
• Being at or near the appropriate weight
• Never smoking cigarettes
• Drinking alcohol rarely or never
• Getting regular vigorous exercise
 Engaging in all 7 practices by older persons resulted in health similar to younger
persons
 Incidence of death decreased as number of health practices increased, esp. for
older persons
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 “The Person” in Health & Illness
• Why people persist in non-healthful behaviors
 immediate pleasures of less healthful behavior
 remote negative consequences
 social pressures to engage in unhealthful practice
 habit of behavior (e.g., drug addiction or dependence)
 lack of awareness of dangers associated with
unhealthful behaviors or how to change behavior

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 “The Person” in Health & Illness
• Personality and illness
 personality = person’s cognitive, affective, and behavioral
tendencies that are stable across time/situation
 evidence linking personality traits to health
• low levels of conscientiousness & poor mental health linked to
heart disease
• anxiety, depression, anger/hostility and pessimism linked to
variety of diseases, esp. heart disease
• negative emotions linked to reaction to stress
• positive emotions (e.g., optimism, hopefulness) linked to lower
illness rates & quicker recovery

• These findings suggest that much more than pathogen exposure

is linked to health and illness and set the stage for the need for
health psychology. 19
IV. Emergence of health psychology

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 Health Psychology
• Relatively new sub-field of psychology
 dates back to the late 1970s
• Still growing
 as researchers uncover the subtle & complex
relationships between “mind” & body
• Areas of concern to health psychologists
 wide ranging & diverse
 include both preventive & therapeutic applications
of psychological principles to improve the
individual's health & well-being
• Related fields
 psychosomatic & behavioral medicine
 Health Psychology: Scope

Health Psychology covers 4 broad areas:

1. Health promotion and maintenance

 people's health behaviors & habits
 cigarette smoking
 diet
 seat-belt use
 Health Psychology: Scope

2. Prevention and treatment of illness

 stress management
 changing health habits to prevent illness
 illness coping and rehabilitation
 Health Psychology: Scope

3. Role of psychological and social factors in the

development of illness
 role of stress in disease onset
 impact of social support
 psychoneuroimmunology (PNI)
 how psychology affects nervous system functioning, and
how this, in turn, affects immunity to disease
 personality correlates of illness & health
 Health Psychology: Scope

4. Health care policy formulation and the health

care system
 how people interact with health care professionals
and institutions, and the effect of these
relationships on the individual's health
 compliance
 recovery time
 Health Psychology: Hot Topics

• Current research interest focus

 impact of cultural factors on health behaviors
 impact of stress on immunity, mood, & cognition
 relationship between childhood abuse & health
 the placebo effect & its biological basis
 efficacy of alternative medicine & strategies and
reasons people use such alternatives to Western
medicine
V. Biopsychosocial model

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 Biopsychosocial Model
• Expands on the biomedical model
 Importance of the interplay of biological, psychological, &
social aspects of a person’s life
• Assumes 3 factors affect and are affected by health/illness
 Biological factors
 Psychological factors
 Social factors

 See slide #33 for a diagram of the Biopsychosocial

Model; please note that BIOLOGICAL factors are the only
ones that DIRECTLY influence health/disease outcome
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 Biopsychosocial Model

• Biological factors
 Genes
• For example, a woman who inherits a harmful mutation of the BRCA-
1 or -2 gene has a greatly elevated chance of developing breast and
ovarian cancer. A man who inherits a harmful mutation of the BRCA-1
or -2 gene has a greater risk of developing breast and prostate
cancer.
 Physiological functioning (including aberrant neurochemistry,
structural defects, & altered immunocompetence)
• For example, those who have autoimmune disorders like
autoimmune hypothyroidism (i.e., insufficient thyroid hormone) are
susceptible to a myriad of physical (e.g., excessive fatigue),
emotional (e.g., depression), and cognitive problems (e.g.,
diminished concentration & memory ability).
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 Biopsychosocial Model
• Psychological factors
 lifestyle and personality (behavior and mental
processes – the focus of psychology)
• cognition: mental activities of perception, thought,
belief, & decision-making influence health/illness
• emotion: positive & negative emotional states influence
and are influenced by health/illness
– influence decisions to seek treatment
• motivation: why people do what they do
– part of explanation for adaptive & maladaptive
health behaviors (e.g., participation in health
intervention programs)

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 Biopsychosocial Model

• Social factors
 peer pressure (e.g., adolescent smoking and drinking)
 societal health values (influenced by the media) can
induce positive &and/or negative health behavior
 community values & community’s environmental
characteristics (e.g., accessibility to playgrounds &
gyms)
 family (e.g., dietary practices)

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 Biopsychosocial Model
• Systems Approach
 addresses “whole person” & acknowledges that
people & reasons for their behavior are complex
 considers all aspects of a person’s life as a total
entity holistic approach
 system = a dynamic entity of continuously interrelated
components with smaller components nested within
larger components (i.e., levels)
• events in one system influence events in other systems

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 PSYCH FACTORS SOC FACTORS
personality BIO FACTORS poverty
self-efficacy genes education
optimism physiology access to med care
social support sex & age ethnic background
stress stress vulnerability cultural beliefs
coping skills immunocompetence racism
risky behavior nutrition chronic illness
adherence: med advice medication

OUTCOMES

Health Disease
 Biopsychosocial Model
• Lifespan perspective
 person is considered in the context of his/her prior,
current, and likely future development
• illnesses experienced vary with age
• biopsychosocial systems change as we age
• Gender/Biological sex perspective
 differences between males & females are considered
in terms of biological functioning, health-related
behaviors, social relationships, & risk for specific
illnesses

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VI. Relating health psychology to
other sciences

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 Related Fields

• Epidemiology: scientific study of distribution &

frequency of disease; branch of medicine that
examines factors that contribute to disease
occurrence in a population
 evolved into scientific discipline in the 1900s as part of
the fight against infectious diseases
 today, epidemiologists also study factors associated
with chronic illness

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 Related Fields
• Epidemiology (continued)
 important terms
 prevalence: proportion of pop affected by a particular disease
at a particular time (includes both continuing & new cases)
 incidence: # of new cases of a disease during a particular time
(usually 1 yr)
 mortality: the number of deaths, usually on a large scale
 morbidity: any illness, injury, or disability
 epidemic: the rapid increase in incidence
 e.g., mortality rate = # of deaths per # of people in a given
population during specified time period
 “rate” adds relativity to meaning
 e.g., mortality rate = # of deaths per # of people in a
given population during specified time period
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 Related Fields
• Public health: concerned with protecting, maintaining
and improving health in the community through
organized effort
• Sociology: evaluates the impact of social factors on
groups or communities of people.
• Anthropology: the study of cultures

• Perspectives from other fields provide a broad

perspective on health/illness and are incorporated into
health psychology to explain influences on health &
illness

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VII. Research methods used in
health psychology

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 Research Methods
• Science: search for regularity, form & order in nature
• Scientific method: set of rules that minimize the
possibility of error, bias & chance occurrence
 hypothesis
• testable proposition or guess
 theory
• tentative explanation of why and under what
circumstances certain phenomena occur
• integration of supported hypotheses into a coherent
whole
• constantly subject to revision (see diagram on slide
#41)
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 Hypothesis

Theory
Empirical
construction &
testing
modification
 Theory

• Characteristics of a good (useful) theory

 clearly stated
 brings together or organizes known facts
 relates information that previously seemed unrelated
 enables predictions
• Role of theory
 guides research by providing a “roadmap” of
relationships to study

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 Research Methods

• Scientific study of behaviors related to health and

disease
 experiments
 correlational studies
 quasi-experimental studies
 genetics research

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 Experiment
• Experiment
 controlled study in which the researcher manipulates
a variable (IV) to study its effects on another variable
(DV)
 e.g., effect of low-fat diet on cardiovascular disease
 e.g., effect of antioxidant ingestion on cancer
 enables identification of cause-effect relationship by
adhering to a set of rules that minimize the
possibility of error, bias & chance occurrence

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 Experimental Method: 5 Steps
1. Formulate hypothesis
2. Design study & run (collect data)
 Choose sample: large, random, representative
 Select variables of interest: IV & DV
 Randomly assign participants to groups
• Equal distribution of characteristics across groups
 Designate groups
• Experimental group: receives one level of the IV (e.g.,
treatment or procedure of interest)
• Control group: receives a different level of the IV and
serves as a point of reference or comparison (placebo
used to rule out participant expectations)

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 Experimental Method: 5 Steps
 Employ double blind approach
 Follow ethical guidelines
3. Analyze data
 Statistics
4. Communicate results
 Publications
 Conferences
5. Replicate Study
 Repeat scientific investigation

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 Correlational Studies
• Correlational study
 describes relationship between variables
• e.g., research on risk factors
 used when data on variables are available, but
variables are only measured, not manipulated
 cannot determine cause-and-effect
 useful for
• examining existing relationships and variables that
cannot be manipulated
• developing hypotheses
• generating predictive information

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 Correlational Studies
• Correlation coefficient: number that indicates the strength &
direction of relationship between 2 variables (ranges from +1.00
to -1.00)
 STRENGTH
• indicated by absolute value of coefficient
 DIRECTION
• positive correlation indicates that increasing scores on one
variable are associated with increasing scores on the
other variable AND decreasing scores on one variable are
associated with decreasing scores on the other variable
• negative correlation indicates that increasing scores on
one variable are associated with decreasing scores on the
other variable
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 Quasi-experimental Studies

• Similar to experiments EXCEPT

 participants are not randomly assigned to the groups
(experimental & control groups form naturally)
 ex post facto study (type of quasi-experiment)
• variables that define the group are not manipulated;
subjects are categorized on the basis of an existing
variable or characteristic (e.g., biological sex)
• e.g., compare coronary heart disease level in people
with different educational levels
 conclusions from quasi-experimental studies are
correlational and not causal

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 Quasi-experimental Studies
• Retrospective & prospective approaches
 retrospective: history of people who have developed a
particular illness is compared to that of control group
• purpose: to find commonalities in people's histories that may
suggest why they developed a disease
• shortcoming: faulty memory  inaccurate reports
 prospective: look forward in lives determine if differences
in one variable at one point in time are related to
differences in another variable at a later time
• more plausible causal connection
• potentially costly & time-consuming approach
 developed by epidemiologists & used to identify risk
factors for specific illnesses
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 Quasi-experimental Studies
• Developmental approaches: designed to study
differences between people of different ages or of the
same people across time
 cross-sectional approach: individuals of different ages
are observed at about the same time
 longitudinal approach: repeated observation of the
same individuals over time (like the prospective
approach)
• costly & time-consuming
• subject to loss of participants over time
• valuable  examining change/stability in lives of participants
 cohort effect: generational effect due to historical
experiences of a group of subjects
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 Quasi-experimental Studies
• Single-subject approaches
 case study: in-depth examination of an individual from
a person’s history, interviews, & current observation
• useful  development & treatment of an unusual problem
 single-subject design: a single participant study; initial
assessment is made before and after some
intervention is made
• useful  effectiveness of new treatment methods
 disadvantage of single-subject approaches
• low generalizability
 advantages
• stimulate development of new treatments
• suggest new topics for research
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 Genetics Research
• Twin studies
 types of twins
• monozygotic (MZ) twins: one egg + one sperm; identical genes
• dizygotic (DZ) twins: 2 ova + 2 sperm; no more genetically similar than
singly born siblings
 research on hereditary factors that compares differences in MZ twins to
differences in DZ twins
• MZ twins share same genetic material  differences between them are
attributed to environmental factors
• differences between DZ twins attributed to both genetic & environmental
factors
• if MZ & same-sexed DZ twins have equivalent environmental experiences
(an assumption), one can measure genetic influence by subtracting
differences between MZ pair from differences between DZ pair
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 Genetics Research
• Adoption studies
 compare traits of adopted children to those of both
natural & adoptive parents
• if children are more similar to their natural parents
than to adoptive  due to genes
• if children more similar to adopted parents  due
to environment

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 Genetics Research
• Findings of twin & adoption studies
 heredity affects physical characteristics &
physiological functioning
 genetic factors affect levels of cholesterol & therefore
heart disease
 heredity has a greater impact (than behavior) early in
life; lifestyle & habits have a greater effect on health in
later life
 environmental factors play a greater role than do
genetic factors in the development of cancer

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 Genetics Research
• Linking specific genes to diseases
 examples of genes related to disease
• sickle-cell anemia: sickle-shaped red blood cells
due to the presence of a recessive gene
• Phenylketonuria (PKU): inherited disease in
which the body fails to produce the enzyme
necessary for metabolizing the amino acid
phenylalanine

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 THE END!

WELCOME TO THE CLASS!

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